Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents

Background: Verruca is one of the common dermatopathologies which has multiple therapeutic options but with variable success rates, refractory cases and high recurrence rates. Nowadays, treatment with intralesional injections has gained recognition due to its effectiveness in clearing verrucae. These act by stimulating the cell-mediated immunity. Out of scores of options available for intralesional therapeutics, Vitamin D3 appears to be more promising but least evaluated. Therefore, we planned to evaluate the efficacy of intralesional Vitamin D3 in various types of cutaneous verrucae. Simultaneously the results were compared with intralesional bleomycin, also. Methods: A total of 200 patients of cutaneous verrucae with varying size and duration were included in the experimental randomized comparative study. We divided them into two groups. Group A, comprising of 100 patients, received 0.2-0.5 ml intralesional Vitamin D3 (600,000 IU, 15mg/ml) and Group B, also of hundred subjects, received intralesional Bleomycin (1 mg/ml) into the base of verrucae. A maximum of 5 verrucae were injected per session at 3 weeks interval until resolution or for a maximum of 4 sessions. Patients were followed up for 6 months after the last injection to assess the clearance status and detect any recurrence. Results: In Group A (Vitamin D3), 'Complete response', 'Partial response' and 'No response' were observed in 85.07%, 6.74% and 8.17% respectively after 4 sessions. Recurrence rate was 0.81% after 6 months. In Group B (Bleomycin), 'Complete response', 'Partial response' and 'No response' were found in 77.99%, 10.47% and 11.53% in the series. Recurrence rate was 1.71%, comparatively higher in group B. Conclusion: The efficacy of intralesional Vitamin D3 was found significantly higher as compared to intralesional Bleomycin in the treatment of cutaneous verrucae with less recurrence rates. Vitamin D3 has an additional advantage of cost-effective treatment over Bleomycin. We purpose its use, as a primary mode of treatment in various types of cutaneous verrucae. Keywords: Bleomycin, Vitamin D3, Verrucae.

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Recurrent Stroke Risk in Pilots with Atrial Fibrillation

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5326.2020 ◽

2020 ◽

Vol 91 (4) ◽

pp. 352-357

Author(s):

Jessica Tedford ◽

Valerie Skaggs ◽

Ann Norris ◽

Farhad Sahiar ◽

Charles Mathers

Keyword(s):

Atrial Fibrillation ◽

General Population ◽

Recurrent Events ◽

Stroke Risk ◽

Event Rate ◽

Recurrent Stroke ◽

Previous History ◽

Recurrent Event ◽

Recurrence Rates ◽

Medical Certification

INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population and is considered disqualifying aeromedically. This study is a unique examination of significant outcomes in aviators with previous history of both AF and stroke.METHODS: Pilots examined by the FAA between 2002 and 2012 who had had AF at some point during his or her medical history were reviewed, and those with an initial stroke or transient ischemic attack (TIA) during that time period were included in this study. All records were individually reviewed to determine stroke and AF history, medical certification history, and recurrent events. Variables collected included medical and behavior history, stroke type, gender, BMI, medication use, and any cardiovascular or neurological outcomes of interest. Major recurrent events included stroke, TIA, cerebrovascular accident, death, or other major events. These factors were used to calculate CHA2DS2-VASc scores.RESULTS: Of the 141 pilots selected for the study, 17.7% experienced a recurrent event. At 6 mo, the recurrent event rate was 5.0%; at 1 yr, 5.8%; at 3 yr 6.9%; and at 5 yr the recurrent event rate was 17.3%. No statistical difference between CHA2DS2-VASc scores was found as it pertained to number of recurrent events.DISCUSSION: We found no significant factors predicting risk of recurrent event and lower recurrence rates in pilots than the general population. This suggests CHA2DS2-VASc scores are not appropriate risk stratification tools in an aviation population and more research is necessary to determine risk of recurrent events in aviators with atrial fibrillation.Tedford J, Skaggs V, Norris A, Sahiar F, Mathers C. Recurrent stroke risk in pilots with atrial fibrillation. Aerosp Med Hum Perform. 2020; 91(4):352–357.

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Early complications in surgery of umbilical and epigastric hernias

Perspectives in Surgery ◽

10.33699/pis.2020.99.5.207-211 ◽

2020 ◽

Vol 99 (5) ◽

pp. 207-211

Keyword(s):

Type 2 Diabetes ◽

Recurrence Rate ◽

Mesh Repair ◽

Early Complications ◽

Recurrence Rates ◽

Fascial Defect ◽

Epigastric Hernia ◽

Mesh Implantation ◽

Hernial Sac

ntroduction: Repairs of umbilical and epigastric hernias are common surgical procedures; the choice of the surgical method generally depends on the size of the hernial sac and fascial defect. Methods: Data of patients operated on for umbilical or epigastric hernias in our hospital during two years were assessed retrospectively. The study group included 264 patients; 212 had an umbilical hernia and 52 had an epigastric hernia. We assessed epidemiologic and clinical parameters and their correlation with the occurrence of early postoperative complications. We also looked for the recurrence rate, although during only a short follow-up period. Results: In the case of umbilical hernias, early complications occurred in 6.7% (11/165) after surgery with a simple suture and in 4.3% (2/47) with mesh repair, and the recurrence rates were 3% (5/165) and 21.3% (10/47), respectively. The risk of early complications was significantly higher in larger hernias. The recurrence rate increased with older age, an increased size of the hernial sac and fascial defect, and in patients with type 2 diabetes. In epigastric hernias, early complications occurred in 5.3% (1/19) after surgery with a simple suture and in 6.1% (2/33) with mesh repair. Recurrences only occurred in operations with mesh repair, in 9% (3/33). The risk of early complications was significantly higher in type 2 diabetes patients. Conclusion: Early complications were slightly more frequent in epigastric hernia repairs with mesh implantation, but this was not the case of umbilical hernias. We recommend mesh implantation in larger and borderline sized hernias to reduce the risk of recurrence.

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Long-term remission and recurrence rates after transsphenoidal surgery for cushing's disease

Endocrine Abstracts ◽

10.1530/endoabs.35.p716 ◽

2014 ◽

Author(s):

Paloma Moreno Moreno ◽

Julia Silva Fernandez ◽

Maria Rosa Alhambra Exposito ◽

Maria angeles Galvez Moreno

Keyword(s):

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Cushing's Disease ◽

Recurrence Rates

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Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2019-0020 ◽

2019 ◽

Vol 12 (2) ◽

pp. 139-146

Author(s):

Mladen E. Ovcharov ◽

Iliya V. Valkov ◽

Milan N. Mladenovski ◽

Nikolay V. Vasilev

Keyword(s):

Recurrence Rate ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Surgical Techniques ◽

Reoperation Rate ◽

University Hospital ◽

Recurrence Rates ◽

Chi Square ◽

Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

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